Healthcare Provider Details

I. General information

NPI: 1235156910
Provider Name (Legal Business Name): ST MICHAEL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NE 128TH ST
NORTH MIAMI FL
33161-4829
US

IV. Provider business mailing address

620 NE 128TH ST
NORTH MIAMI FL
33161-4829
US

V. Phone/Fax

Practice location:
  • Phone: 305-981-1015
  • Fax: 305-981-1016
Mailing address:
  • Phone: 305-981-1015
  • Fax: 305-981-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0065663
License Number StateFL

VIII. Authorized Official

Name: MR. JOSEPH M LEMAIRE
Title or Position: PRESIDENT
Credential: M.D., M.PH
Phone: 305-981-1015